Urban health challenges in India – lessons learned from a surveillance study in Pune

Keywords: Urban health, public health, disease surveillance, non-communicable diseases, Pune, India


Urban health in India is gaining increasing attention due to the growing share of urban population and the changing living conditions caused by the rapid urbanization process. The rising prevalence of non-communicable diseases (NCDs) such as diabetes is partly attributed to this process making NCD prevention and control one of the biggest public health challenges in the 21th century. Though public health programs in India are increasingly targeting NCDs, data quality and availability to budget scarce resources remains a challenge.

The objective of the study was to conceptualize a prototype for an urban NCD sentinel surveillance system to capture data on newly diagnosed NCD cases, taking also into account socio-spatial intraurban differences. As preliminary steps, two systematic literature reviews, mapping of healthcare providers and a knowledge attitude practice survey on disease surveillance were conducted. In total, 258 private primary healthcare providers (allopathy, ayurveda, homeopathy and unani) participated in the survey, out of these 127 agreed to participate in the six months surveillance study, providing data on a monthly basis.

The study indicates that, despite the small size and low level of infrastructure in the private clinics, these practitioners play an important role in diagnosing and treating NCDs. They can be involved in NCD surveillance, if the following major barriers are addressed: lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. Based on our findings, a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care might be an adequate approach to monitor NCD related health trends.

Author Biography

Mareike Kroll, University of Cologne, Germany Institute of Geography
Institute of Geography Postdoctoral research fellow


Alwan, A., D.R. MacLean DR, L.M. Riley, E.T. d'Espaignet, C.D. Mathers, G.A. Stevens et al. 2010: Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. – Lancet 376: 1861-68. DOI:10.1016/S0140-6736(10)61853-3

Baru RV 2013: Challenges for regulating the private health services in India for achieving universal health care. – Indian Journal of Public Health 57 (4): 208-11. Online available: http://www.ijph.in/text.asp?2013/57/4/208/123243 – accessed online 01/12/2016

Federal Office of Public Health, Switzerland (no year). The Swiss Sentinel Surveillance Network. Online available at: http://www.bag.admin.ch/k_m_meldesystem/00736/00817/ index.html?lang=en – accessed online 01/12/2016

Butsch, C. 2011: Zugang zu Gesundheitsdienstleistungen. Barrieren und Anreize in Pune, Indien. – Stuttgart

Census 2011. City Census 2011. Online available: http://www.census2011.co.in/city.php – accessed online 15/12/2016

Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of India 2015: Annual report 2015-16. Online available: http://www.mohfw.nic.in/ index1.php?lang=1&level=2&%20sublinkid=6140&lid=3991 – accessed online 01/12/2016

Gupta, S, V.P. Shenoy, I. Bairy, H. Srinivasa and C. Mukhopadhyay 2011: Diabetes mellitus and HIV as co-morbidities in tuberculosis patients of rural south India. – Journal of Infectious and Public Health 4 (3): 140-44. DOI: 10.1016/j.jiph.2011.03.005.

Hall H.I., A. Correa, P.W. Yoon and C.R. Braden 2012: Lexicon, definitions, and conceptual framework for public health surveillance. Morbidity and Mortality Weekly Report 61 (03): 10-14. Online available http://www.cdc.gov/mmwr/preview/ind2012_su.html – accessed online 01/12/2016

Harries, A.D., A.M. Kumar, S. Satyanarayana, Y. Lin, R. Zachariah, K. Lo¨nnroth et al. 2015. Diabetes mellitus and tuberculosis: programmatic management issues. – International Journal of Tuberculosis and Lung Disease 19 (8): 879-86. DOI: 10.5588/ijtld.15.0069

International Institute for Population Sciences (IIPS), Macro International 2007. National Family Health Survey (NFHS-3), 2005-06: India: Volume I. Mumbai. Online available: http://dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1andVol2.pdf – accessed online 01/12/2016

Khan, S., R. Kunz, J. Kleijnen and G. Antes 2003. Five steps to conducting a systematic review. – Journal oft he Royal Society of Medicine 96 (3): 118-121.

Klaucke, D., J. Buehler, S. Thacker, R. Parrish, F. Trowbridge, R. Berkelman and the Surveillance Coordination Group 1988. Guidelines for Evaluation Surveillance Systems. Morbidity and Mortality Weekly Report Supplements 37 (5): 1-18. Online available: https://www.cdc.gov/mmwr/preview/mmwrhtml/00001769.htm – accessed online 01/12/2016

Kolenikov S. and G. Angeles 2009. Socioeconomic status measurement with discrete proxy variables: is principal component analysis a reliable answer? Review of Income and Wealth 55 (1): 128-65.

Kraas, F. and C. Butsch 2016: Wo beginnt die Stadt? Transformation und urbane Pfadabhängigkeiten in Pune/Indien. – In: Berr, K. and H. Friesen (eds.): Stadt und Land. Zwischen Status quo und utopischem Ideal. Münster: 155-179.

Kroll, M. 2013: Gesundheitliche Disparitäten im urbanen Indien. Auswirkungen des sozioökonomischen Status auf die Gesundheit in Pune. – Stuttgart.

Kroll, M., E. Bharucha and F. Kraas 2014. Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India. – Global Health Action 7: 23447. DOI: http://dx.doi.org/10.3402/gha.v7.23447

Kroll, M. 2015. Evidenzbasierte Daten zur Kontrolle nicht-übertragbarer Erkrankungen in Indien - eine Pilotstudie zu Gesundheitsberichterstattung im privaten Gesundheitssektor in Pune. – In: Poerting, J. and M. Keck (eds.): Aktuelle Forschungsbeiträge zu Südasien. Band 3. Heidelberg: 17-20.

Kroll, M., R. Phalkey, S. Dutta, S. Shukla, C. Butsch, E. Bharucha and F. Kraas 2016. Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India. – Global Health Action 9: 32635. http://dx.doi.org/10.3402/gha.v9.32635

Kroll, M., R. Phalkey and F. Kraas 2015: Challenges to the surveillance of non-communicable diseases – a review of selected approaches. – BMC Public Health 15: 1243. DOI: 10.1186/s12889-015-2570-z

Maharashtra Social Housing and Action League (MASHAL) 2011: Pune Slum Atlas. Prepared in association with Slum Redevelopment Authority, Urban Community Development, Pune Municipal Corporation and Community Housing Federation (CHF) International. Pune

M’ikanatha, N.M., R. Lynfield, K.G. Julian, C.A. Van Beneden and H. de Valk 2013. Infectious disease surveillance: a cornerstone for prevention and control. – In: M’ikanatha, N.M., R. Lynfield, C.A. Van Beneden and H. de Valk (eds.): Infectious Disease Surveillance: 1-20. DOI: 10.1002/9781118543504

Macfarlane, S.B. 2005: Harmonizing health information systems with information systems in other social and economic sectors. – Bulletin of the World Health Organization 83 (8): 590-95.

Mohan, S. K.S. Reddy and D. Prabhakaran 2011. Chronic non-communicable diseases in India. Reversing the tide. New Delhi: Public Health Foundation India.

Nolen, L.B., P. Braveman, J.N.W. Dachs, I. Delgado, E. Gakidou, K. Moser et al. 2005. Strengthening health information systems to address health equity challenges. – Bulletin of the World Health Organization 83 (8):597 – 602. Online available: http://www.who.int/bulletin/volumes/83/8/597.pdf – accessed online 01/12/2016

Pandey, V. 2009: Crisis of urban Middle Class. – Jaipur

Phalkey, R., M. Kroll, S. Dutta, S. Shukla, C. Butsch, E. Bharucha and F. Kraas 2015: Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India. – Global Health Action 8: 28413. DOI: http://dx.doi.org/10.3402/gha.v8.28413

Pune Municipal Corporation (PMC) 2012: Revising/Updating the City Development Plan (CPD) of Pune City-2014 under JNUURM. – Pune.

Raban, M.Z., R. Dandona and L. Dandona 2012: Availability of data for monitoring noncommunicable disease risk factors in India. Bulletin of the World Health Organization 90 (1): 20-29. Online available: http://www.who.int/bulletin/volumes/90/1/11-091041/en/ – accessed online 01/12/2016

Rajan, V. and D. Prabhakaran 2012: Non-communicable diseases in India: transitions, burden of disease and risk factors – a short story. India Health Beat 6 (1). Online available:

Reddy, K.S. 2015: India’s aspirations for universal health coverage. New England Journal of Medicine 373: 1-5. DOI: 10.1056/NEJMp1414214

Shaw, A. 1999: Emerging Patterns of Urban Growth in India. Economic and Political Weekly 34 (16/17): 969–78

UN DESA – United Nations Department of Economic and Social Affairs 2015: World Urbanization Prospects. The 2014 Revision. Final Report (ST/ESA/SER.A/366). New York: UN DESA. Online available: https://esa.un.org/unpd/wup/Publications/Files/WUP2014-Report.pdf – accessed online 01/12/2016

UNDP India 2014: Maharashtra Human Development Report 2012. New Delhi. Online available: http://www.in.undp.org/content/dam/india/docs/human-development/MHDR%20English-2012.pdf – accessed online 07/12/2016

United Nations 2012. Prevention and control of noncommunicable diseases. Outcomes of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases and the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control. New York: UN; 2012. Online available: http://apps.who.int/gb/e/e_wha65.html – accessed online 01/12/2016

WBGU – German Advisory Council on Global Change 2016: Humanity on the move: Unlocking the transformative power of cities. Berlin: WBGU. Online available: http://www.wbgu.de/en/flagship-reports/fr-2016-urbanization/ – accessed online 01/12/2016

WHO – World Health Organization. 2013. Global action plan for the prevention and control of noncommunicable diseases 2013 – 2020. Geneva: WHO. Online available: http://www.who.int/nmh/publications/ncd-action-plan/en/ – accessed online 01/12/2016

WHO – World Health Organization 2014: Global status report on noncommunicable diseases 2014. Geneva: World Health Organization. Online available: http://www.who.int/nmh/publications/ncd-status-report-2014/en/ – accessed online 01/12/2016

WHO – World Health Organization 2014b: Noncommunicable diseases country profiles. Geneva: World Health Organization. Online available: http://www.who.int/nmh/publications/ncd-profiles-2014/en/ – accessed online 01/12/2016

WHO and UN-Habitat 2016: Global Report on urban health: equitable, healthier cities for sustainable development. WHO, Geneva. Online available: http://www.who.int/kobe_centre/measuring/urban-global-report/en/ – accessed online 01/12/2016

WHO and UN-Habitat 2010: Hidden cities: Unmasking and overcoming health inequities in urban settings. WHO: Geneva. Online available: http://www.who.int/kobe_centre/publications/hidden_cities2010/en/ – accessed online 01/12/2016

World Bank 2011: NCDs Policy Brief - India. The World Bank, South Asia Human Development, Health Nutrition and Population, 2011. Online available: http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546-1296680097256/7707437-1296680114157/NCD_IN_Policy_Feb_2011.pdf – accessed online 01/12/2016

Yiannakoulias, N., L.W. Svenson and D.P. Schopflocher 2009: An integrated framework for the geographic surveillance of chronic disease. – International Journal of Health Geographics 8:69. DIO: 10.1186/1476-072X-8-69

How to Cite
Kroll, M., Phalkey, R., Dutta, S., Bharucha, E., Butsch, C., & Kraas, F. (2017). Urban health challenges in India – lessons learned from a surveillance study in Pune. DIE ERDE – Journal of the Geographical Society of Berlin, 148(1), 74-87. https://doi.org/10.12854/erde-148-31
Research articles